Trends and clinical characteristics of COVID-19 vaccine recipients: a federated analysis of 57.9 million patients' primary care records <i>in situ</i> using OpenSAFELY

Curtis, Helen J; Inglesby, Peter; Morton, Caroline E; MacKenna, Brian; Green, Amelia; Hulme, William J; Walker, Alex J; Morley, Jessica; Mehrkar, Amir; Bacon, Seb; Hickman, George; Bates, Chris; Croker, Richard; Evans, David; Ward, Tom; Cockburn, Jonathan; Davy, Simon; Bhaskaran, Krishnan; Schultze, Anna; Rentsch, Christopher T; Williamson, Elizabeth; Rowan, Anna; Fisher, Louis; McDonald, Helen I; Tomlinson, Laurie; Mathur, Rohini; Drysdale, Henry; Eggo, Rosalind M; Wing, Kevin; Wong, Angel; Forbes, Harriet; Parry, John; Hester, Frank; Harper, Sam; O’Hanlon, Shaun; Eavis, Alex; Jarvis, Richard; Avramov, Dima; Griffiths, Paul; Fowles, Aaron; Parkes, Nasreen; Douglas, Ian; Evans, Stephen; Smeeth, Liam; Goldacre, Ben

doi:10.3399/bjgp.2021.0376

Cited by 89 publications

(75 citation statements)

References 12 publications

(13 reference statements)

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“…There were significant differences in vaccine coverage by demographics, occupation setting, and staff group. Similar differences by factors such as age, sex, ethnicity, and occupation have been reported in other studies [ 14 , 15 , 16 ]. The differences in vaccine coverage that we reported among this population highlights the importance of an equitable vaccination program to all HCWs in Kuwait.…”

Section: Discussionsupporting

confidence: 88%

Effectiveness of BNT162b2 and ChAdOx1 Vaccines against Symptomatic COVID-19 among Healthcare Workers in Kuwait: A Retrospective Cohort Study

et al. 2021

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Background: Estimating vaccine effectiveness (VE) against severe, acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among healthcare workers (HCWs) is necessary to demonstrate protection from the disease. Between 24 December 2020 and 15 June 2021, we determined the factors associated with vaccine coverage and estimated VE against SARS-CoV-2 infection in HCWs at a secondary hospital in Kuwait. Methods: We extracted sociodemographic, occupational, SARS-CoV-2 infection, and vaccination data for eligible HCWs from the hospital records. Vaccine coverage percentages were cross-tabulated with the HCW factors. Cox regression was used to estimate hazard ratios in vaccinated versus unvaccinated. Results: 3246 HCWs were included in the analysis, of which 82.1% received at least one vaccine dose (50.4% only one dose of ChAdOx1, 3.3% only one dose of BNT162b2, and 28.3% two doses of BNT162b2). However, 17.9% of HCWs were unvaccinated. A significantly lower vaccination coverage was reported amongst female HCWs, younger age group (20–30 years), and administrative/executive staff. The adjusted VE of fully vaccinated HCWs was 94.5% (95% CI = 89.4–97.2%), while it was 75.4% (95% CI = 67.2–81.6%) and 91.4% (95% CI = 65.1–97.9%) in partially vaccinated for ChAdOx1 and BNT162b2, respectively. Conclusions: BNT162b2 and ChAdOx1 vaccines prevented most symptomatic infections in HCWs across age groups, nationalities, and occupations.

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Section: Discussionsupporting

confidence: 88%

Effectiveness of BNT162b2 and ChAdOx1 Vaccines against Symptomatic COVID-19 among Healthcare Workers in Kuwait: A Retrospective Cohort Study

et al. 2021

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“…However, adjusted associations in this study may still be biased by unmeasured confounding by patient characteristics that predict both vaccination and thromboses and that are difficult to ascertain in electronic health records. Examples include general health at the time of vaccination, and people at higher risk of thromboses (for example, with end-stage diseases) [ 18 ]. There were slightly lower postvaccination rates of the “negative control” outcome lower limb fracture in those aged ≥70 years, which are likely due to unmeasured confounding.…”

Section: Discussionmentioning

confidence: 99%

Association of COVID-19 vaccines ChAdOx1 and BNT162b2 with major venous, arterial, or thrombocytopenic events: A population-based cohort study of 46 million adults in England

Whiteley

Cooper

et al. 2022

PLoS Med

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Background Thromboses in unusual locations after the Coronavirus Disease 2019 (COVID-19) vaccine ChAdOx1-S have been reported, although their frequency with vaccines of different types is uncertain at a population level. The aim of this study was to estimate the population-level risks of hospitalised thrombocytopenia and major arterial and venous thromboses after COVID-19 vaccination. Methods and findings In this whole-population cohort study, we analysed linked electronic health records from adults living in England, from 8 December 2020 to 18 March 2021. We estimated incidence rates and hazard ratios (HRs) for major arterial, venous, and thrombocytopenic outcomes 1 to 28 and >28 days after first vaccination dose for ChAdOx1-S and BNT162b2 vaccines. Analyses were performed separately for ages <70 and ≥70 years and adjusted for age, age2, sex, ethnicity, and deprivation. We also prespecified adjustment for anticoagulant medication, combined oral contraceptive medication, hormone replacement therapy medication, history of pulmonary embolism or deep vein thrombosis, and history of coronavirus infection in analyses of venous thrombosis; and diabetes, hypertension, smoking, antiplatelet medication, blood pressure lowering medication, lipid lowering medication, anticoagulant medication, history of stroke, and history of myocardial infarction in analyses of arterial thromboses. We selected further covariates with backward selection. Of 46 million adults, 23 million (51%) were women; 39 million (84%) were <70; and 3.7 million (8.1%) Asian or Asian British, 1.6 million (3.5%) Black or Black British, 36 million (79%) White, 0.7 million (1.5%) mixed ethnicity, and 1.5 million (3.2%) were of another ethnicity. Approximately 21 million (46%) adults had their first vaccination between 8 December 2020 and 18 March 2021. The crude incidence rates (per 100,000 person-years) of all venous events were as follows: prevaccination, 140 [95% confidence interval (CI): 138 to 142]; ≤28 days post-ChAdOx1-S, 294 (281 to 307); >28 days post-ChAdOx1-S, 359 (338 to 382), ≤28 days post-BNT162b2-S, 241 (229 to 253); >28 days post-BNT162b2-S 277 (263 to 291). The crude incidence rates (per 100,000 person-years) of all arterial events were as follows: prevaccination, 546 (95% CI: 541 to 555); ≤28 days post-ChAdOx1-S, 1,211 (1,185 to 1,237); >28 days post-ChAdOx1-S, 1678 (1,630 to 1,726), ≤28 days post-BNT162b2-S, 1,242 (1,214 to 1,269); >28 days post-BNT162b2-S, 1,539 (1,507 to 1,572). Adjusted HRs (aHRs) 1 to 28 days after ChAdOx1-S, compared with unvaccinated rates, at ages <70 and ≥70 years, respectively, were 0.97 (95% CI: 0.90 to 1.05) and 0.58 (0.53 to 0.63) for venous thromboses, and 0.90 (0.86 to 0.95) and 0.76 (0.73 to 0.79) for arterial thromboses. Corresponding aHRs for BNT162b2 were 0.81 (0.74 to 0.88) and 0.57 (0.53 to 0.62) for venous thromboses, and 0.94 (0.90 to 0.99) and 0.72 (0.70 to 0.75) for arterial thromboses. aHRs for thrombotic events were higher at younger ages for venous thromboses after ChAdOx1-S, and for arterial thromboses after both vaccines. Rates of intracranial venous thrombosis (ICVT) and of thrombocytopenia in adults aged <70 years were higher 1 to 28 days after ChAdOx1-S (aHRs 2.27, 95% CI: 1.33 to 3.88 and 1.71, 1.35 to 2.16, respectively), but not after BNT162b2 (0.59, 0.24 to 1.45 and 1.00, 0.75 to 1.34) compared with unvaccinated. The corresponding absolute excess risks of ICVT 1 to 28 days after ChAdOx1-S were 0.9 to 3 per million, varying by age and sex. The main limitations of the study are as follows: (i) it relies on the accuracy of coded healthcare data to identify exposures, covariates, and outcomes; (ii) the use of primary reason for hospital admission to measure outcome, which improves the positive predictive value but may lead to an underestimation of incidence; and (iii) potential unmeasured confounding. Conclusions In this study, we observed increases in rates of ICVT and thrombocytopenia after ChAdOx1-S vaccination in adults aged <70 years that were small compared with its effect in reducing COVID-19 morbidity and mortality, although more precise estimates for adults aged <40 years are needed. For people aged ≥70 years, rates of arterial or venous thrombotic events were generally lower after either vaccine compared with unvaccinated, suggesting that either vaccine is suitable in this age group.

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“…[32] Our survey also showed that those with lower levels of education and those belonging to the working class were less likely to be vaccinated, as found in a British survey covering the first 100 days of the vaccine rollout. [7] This could relate to the fact that members of the working classes have a perception of their body and their health that is more distant from medical diagnoses and recommendations than the upper class. [33] Racialised minorities, who had greater reluctance towards receiving a Covid-19 vaccine in France and in many countries [13,31] also appeared to be less likely to be vaccinated, as found in British and US surveys.…”

Section: Discussionmentioning

confidence: 99%

“…[1][2][3] Making Covid-19 vaccines available does not necessarily lead to a very large population vaccine coverage, as shown by the percentages of people who are still not vaccinated in Western countries [4], even when these vaccines are free. Recent studies in the UK, in the US and in Norway [5][6][7][8][9][10] have shown that the most socially disadvantaged and racialised social groups are the least vaccinated. In light of their high risk of infection and mortality from Covid-19 [1], it appears all the more important to understand why they are less likely to be reached by Covid-19 vaccine programmes.…”

Section: Introductionmentioning

confidence: 99%

When mistrust in the government and scientists reinforce social inequalities in vaccination against Covid-19

Bajos

Spire

Silberzan

et al. 2022

Preprint

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Objective To assess whether mistrust in the government and scientists reinforces social and racial inequalities in vaccination practises Design A follow-up of a random population-based cohort survey. Setting In July 2021, in France. Participants 80,971 participants aged 18 years and more. Main outcome measures Adjusted odds ratios of Covid-19 vaccination status (received at least one dose/ intends to get vaccinated/ does not know whether to get vaccinated/refuses vaccination) were assessed using multinomial regressions to test associations with social and mistrust factors and to study how these two factors interacted with each other. Results In all, 72.2% were vaccinated at the time of the survey. The population of unvaccinated people was younger, less educated, had lower incomes, and more often belonged to racialised minorities, as compared to vaccinated people. Mistrust of government and scientists to curb the spread of the epidemic were the factors most associated with refusing to be vaccinated: OR=8.86 (7.13 to 11.00) for the government and OR=9.07 (7.71 to 10.07) for scientists, compared to vaccinated people. Mistrust was more prevalent among the poorer which consequently reinforced social inequalities in vaccination. The 10% poorest who did not trust the government reached an OR of 16.2 (11.9 to 22) for refusing to be vaccinated compared to the 10% richest who did. Conclusion There is a need to develop depoliticised outreach programmes targeted at the most socially disadvantaged groups, and to design vaccination strategies conceived with people from different social and racial backgrounds to enable them to make fully informed choices.

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Trends and clinical characteristics of COVID-19 vaccine recipients: a federated analysis of 57.9 million patients' primary care records in situ using OpenSAFELY

Cited by 89 publications

References 12 publications

Effectiveness of BNT162b2 and ChAdOx1 Vaccines against Symptomatic COVID-19 among Healthcare Workers in Kuwait: A Retrospective Cohort Study

Effectiveness of BNT162b2 and ChAdOx1 Vaccines against Symptomatic COVID-19 among Healthcare Workers in Kuwait: A Retrospective Cohort Study

Association of COVID-19 vaccines ChAdOx1 and BNT162b2 with major venous, arterial, or thrombocytopenic events: A population-based cohort study of 46 million adults in England

When mistrust in the government and scientists reinforce social inequalities in vaccination against Covid-19

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